• MAPA 520.795.5830
    Oficina del Noroeste
  • MAPA 520.795.5830
    Oficina del Este
  • MAPA 520.795.5830
    River Rd Oficina

HIPAA Acknowledgement and Consent to Treat

HIPAA Acknowledgement and Consent to Treat

01.22.2014 | Acerca de su cuidado, Formularios para Pacientes

Aviso de prácticas de privacidad

Download the HIPAA Acknowledgement and Consent to Treat Form

Este aviso describe cómo se puede usar la información médica sobre usted y divulgada y cómo usted puede tener acceso a esta información. Por favor, revise con cuidado. To view the entire Notice of Privacy Practices you may download the Privacy document via the link above.
Effective September 23, 2013

Our Pledge Regarding Medical Information
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Provider. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated or maintained by the Provider, whether made by Provider personnel or your personal doctor.

This Notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:
• Make sure that medical information that identifies you is kept private;
• Give you this Notice of our legal duties and privacy practices with respect to medical information about you; y
• Follow the terms of the Notice that is currently in effect.

 

Who Will Follow This Pledge?
This Notice describes Urological Associates of Southern Arizona, P.C. (hereafter referred to as ‘Provider’) Privacy Practices and that of:

Any workforce member authorized to create medical information referred to as Protected Health Information (PHI) which may be used for purposes such as Treatment, Payment and Healthcare Operations. These workforce members may include:
• All departments and units of the Provider.
• Any member of a volunteer group.
• All employees, staff and other Provider personnel.
• Any entity providing services under the Provider’s direction and control will follow the terms of this notice. Además, these entities, sites and locations may share medical information with each other for Treatment, Payment or Healthcare Operational purposes described in this Notice.

 

Quejas

Usted puede presentar una queja ante nosotros o ante el Secretario de Salud y Servicios Humanos si usted cree que hemos violado sus derechos de privacidad. Usted puede presentar una queja con nosotros notificando nuestro contacto de privacidad de su queja. No tomaremos represalias contra usted por presentar una queja.

UASA se reserva el derecho de cambiar sus políticas y procedimientos, según sea necesario y hará esta notificación disponibles a pedido de personas siempre que se aplique un cambio sustancial.

Puede ponerse en contacto, escrito, nuestro administrador para obtener más información sobre el proceso de queja en:

Associates urológicas de Arizona meridional Atención:
Administrador
6325 Este Tanque Verde Camino
Tucson, LA 85715